P09S02: Chronic
obstructive pulmonary disease
Bottom line: Information on chronic
obstructive pulmonary disease was used to maintain the management of the patient (maintain the antibiotics, and maximize the dose of inhalers). There
were no information-related patient health outcomes.
Level 1 outcome (situational relevance): On August 1, 2008, P09 did a search at work, by themselves, and after
an encounter with a patient. They retrieved three information hits about chronic obstructive pulmonary disease [COPD]. The reported search objective was to address a clinical question. [The patient was] a man, 92 years
old, [...] who was having increasing difficulties with breathing. But I was
[aware] that he often had a lot of co-morbid conditions, CHF [congestive heart
failure] and glaucoma and arrhythmia. So, I was trying to figure out which
antibiotics to use. [...] And I also wanted to know if I could increase any of
his inhalers... and what other inhalers I could add. I was looking for Spiriva.
Let's see if there were any contraindications to use it for somebody with
co-morbid conditions. [...] I was trying to figure out the maximum doses of
Atrovent and Symbicort. And Spiriva wasn't an option in this case; he couldn't
afford it, so. According to P09, the information from
e-Therapeutics+ was in agreement with and equally relevant as the information
from another electronic resource (COPD guidelines), and in agreement with but
more relevant than the information from a paper-based resource (CPS).
Level 2 outcome (cognitive impact): One hit was associated with a report of positive cognitive impact (see table). Regarding practice
improvement, P09 stated: It just gave me
more of a range for antibiotics. [...] Looking at what just the first choice of
antibiotics would be better, so it [my practice] was improved. [...] I would
have often just used fluoroquinolone, and now I know theyre actually the
alternatives, not necessarily the first line. The two other hits were associated with positive cognitive impact
(such as confirmation): I was thinking of maximizing
the doses [of inhalers] already, before I even searched. I also was thinking of
using Spiriva already before I did the search. [
] I just went to search just
in case.
Retrieved
information hit(s):
1) e-Therapeutics+ (CIRT): Therapeutics tab COPD Chapter on respiratory disorders: COPD -Table 2 antibiotics (P09S02H01)
2) e-Therapeutics+ (CIRT):
Therapeutics tab COPD Chapter on
respiratory disorders: COPD - Table 3 inhalers (P09S02H02)
3) e-Therapeutics+ (CIRT): Therapeutics tab COPD Chapter on respiratory disorders: COPD -Table 5 antibiotics (P09S02H03)
Level 3 outcome
(information use): Information on COPD was retrieved, and used
to maintain (be more certain about) the management of
the patient (information used as presented in e-Therapeutics+). I was thinking
of maximizing the doses already, before I even searched. I also was thinking of
using Spiriva already, before I did the search. [...] His symptoms were such
that the medications had to be changed, had to be maximized, because he was
symptomatic, he was having an exacerbation. [
] I already made the changes in
the plan but I went [in e-Therapeutics+] the next day to see if there was
anything else I needed to do. And to confirm, to make sure that there wasn't
anything that I could have done differently [both for antibiotics and
inhalers].
Level 4 outcome (patient health): Without this
information, P09s management of the patient would have been the same. There
were no clear relationships between the use of information and expected patient
health outcomes.
Levels of outcome of information-seeking
|
Situational relevance |
Positive cognitive
impact |
Information use |
Patient health |
|
Address a clinical question |
Practice improved Learned something Reminded something Motivated to learn Confirmed Reassured |
Be more certain |
No outcome |